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GLUCAGON LIKE PEPTIDE-1 (GLP-1) AGONISTS USE IS NOT ASSOCIATED WITH WORSE OUTCOMES OR INCREASED MORTALITY POST ENDOSCOPY: A MULTI-CENTER ANALYSIS
Date
May 18, 2024
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Introduction
Glucagon Like Peptide-1 (GLP-1) agonists exert their effect by inhibiting postprandial glucagon secretion, promoting glucose-dependent insulin secretion and mitigating food consumption by delaying gastric emptying. Concern for retention of gastric contents while performing esophagogastroduodenoscopy (EGD) leading to possible worse cardiovascular complications has been a recent alarming issue in the field. We aim to evaluate immediate post endoscopic outcomes in patients using GLP-1 agonists.
Methods
A retrospective cohort study utilizing the TriNetX platform was performed. Adult patients using GLP-1 agonists who underwent EGD between January 1, 2020 and December 31, 2022 were included. This cohort of patients was matched with patients who were not using GLP-1 agonists according to age, demographics, comorbidities, and medication by using 1:1 propensity matching. The primary endpoint was mortality within one week after EGD. Secondary endpoints were: cardiopulmonary adverse event rates within one week after EGD, including acute respiratory failure (ARF), aspiration pneumonia, needs for mechanical ventilation, cardiorespiratory arrest, acute coronary syndrome (ACS), coronary artery interventions, and ischemic stroke. Cox proportional hazard models were used to estimate hazard ratios (HRs).
Results
A total of 41,367 adult patients were identified who underwent EGD during the study period. Out of these patients, 581 individuals were using GLP -1 agonists. 571 out of 581(mean [Standard Deviation [SD]] age, 59.10 [12.90] years; 324 [56.74%] female) were matched with 571 individuals as a control group who were not using GLP-1 agonists (mean [SD] age, 58.60 [15.30] years; 325 [56.92%] female). There was no difference in mortality in the group using GLP-1 agonists when compared with control group [HR 0.23; 95% Confidence Interval (CI) (0.06-0.81)]. There was no difference in ARF [HR, 1.07; (0.07-17.03)], shock [HR -0.099 (-1.408- 1.209)], aspiration pneumonia [HR, 1.87; (0.17-20.64) and need for mechanical ventilation [HR, 0.23; (0.03-2.09)]. No patients had any ACS or cardiac-arrest events in both groups. There was a lower risk of ischemic stroke [HR, -2.37; ( -3.82 - -0.92) in the GLP-1 agonist group.
Discussion
Our study reveals that patients on GLP-1 agonists do not have worse post-immediate outcomes when undergoing upper endoscopic procedures. Further studies are needed to evaluate if discontinuation of these medications is beneficial prior to an upper endoscopic intervention.
Glucagon Like Peptide-1 (GLP-1) agonists exert their effect by inhibiting postprandial glucagon secretion, promoting glucose-dependent insulin secretion and mitigating food consumption by delaying gastric emptying. Concern for retention of gastric contents while performing esophagogastroduodenoscopy (EGD) leading to possible worse cardiovascular complications has been a recent alarming issue in the field. We aim to evaluate immediate post endoscopic outcomes in patients using GLP-1 agonists.
Methods
A retrospective cohort study utilizing the TriNetX platform was performed. Adult patients using GLP-1 agonists who underwent EGD between January 1, 2020 and December 31, 2022 were included. This cohort of patients was matched with patients who were not using GLP-1 agonists according to age, demographics, comorbidities, and medication by using 1:1 propensity matching. The primary endpoint was mortality within one week after EGD. Secondary endpoints were: cardiopulmonary adverse event rates within one week after EGD, including acute respiratory failure (ARF), aspiration pneumonia, needs for mechanical ventilation, cardiorespiratory arrest, acute coronary syndrome (ACS), coronary artery interventions, and ischemic stroke. Cox proportional hazard models were used to estimate hazard ratios (HRs).
Results
A total of 41,367 adult patients were identified who underwent EGD during the study period. Out of these patients, 581 individuals were using GLP -1 agonists. 571 out of 581(mean [Standard Deviation [SD]] age, 59.10 [12.90] years; 324 [56.74%] female) were matched with 571 individuals as a control group who were not using GLP-1 agonists (mean [SD] age, 58.60 [15.30] years; 325 [56.92%] female). There was no difference in mortality in the group using GLP-1 agonists when compared with control group [HR 0.23; 95% Confidence Interval (CI) (0.06-0.81)]. There was no difference in ARF [HR, 1.07; (0.07-17.03)], shock [HR -0.099 (-1.408- 1.209)], aspiration pneumonia [HR, 1.87; (0.17-20.64) and need for mechanical ventilation [HR, 0.23; (0.03-2.09)]. No patients had any ACS or cardiac-arrest events in both groups. There was a lower risk of ischemic stroke [HR, -2.37; ( -3.82 - -0.92) in the GLP-1 agonist group.
Discussion
Our study reveals that patients on GLP-1 agonists do not have worse post-immediate outcomes when undergoing upper endoscopic procedures. Further studies are needed to evaluate if discontinuation of these medications is beneficial prior to an upper endoscopic intervention.
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